scholarly journals Bilateral versus unilateral hip arthroscopy for femoroacetabular impingement: a systematic review

2020 ◽  
Vol 7 (2) ◽  
pp. 225-232
Author(s):  
Claire E Fernandez ◽  
Allison M Morgan ◽  
Ujash Sheth ◽  
Vehniah K Tjong ◽  
Michael A Terry
Keyword(s):  
Systematic Review ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Case Reports ◽  
Case Series ◽  
Return To Sport ◽  
Harris Hip Score ◽  
Study Patient ◽  
Significant Difference ◽  
Patient Reported

Abstract One in four patients presenting with femoroacetabular impingement (FAI) has bilateral symptoms, and despite excellent outcomes reported after arthroscopic treatment of FAI, there remains a paucity of data on the outcomes following bilateral hip arthroscopy. This systematic review aims to examine the outcomes following bilateral (either ‘simultaneous’ or ‘staged’) versus unilateral hip arthroscopy for FAI. A systematic review of multiple electronic databases was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and checklist. All studies comparing simultaneous, staged and/or unilateral hip arthroscopy for FAI were eligible for inclusion. Case series, case reports and reviews were excluded. All study, patient and hip-specific data were extracted and analyzed. The Newcastle–Ottawa Scale was used to assess study quality. A meta-analysis was not performed due to heterogeneity among outcome measures. A total of six studies, including 722 patients (42.8% male) and 933 hips were eligible for inclusion. The mean age across patients was 35.5. The average time between staged procedures was 7.7 months. Four of the six studies were retrospective cohort studies, while the remaining two were prospective in nature. The overall quality of the eligible studies was found to be good. No significant difference was noted among patient-reported outcomes (modified Harris hip score, hip outcome score and non-arthritic hip score), visual analog scale, return to sport, traction time and complications between those undergoing bilateral (simultaneous or staged) versus unilateral hip arthroscopy. Based on the current available evidence, bilateral hip arthroscopy (whether simultaneous or staged) exhibits similar efficacy and safety when compared with unilateral hip arthroscopy. However, further prospective study is required to confirm this finding.

When Do Patients Improve After Hip Arthroscopy for Femoroacetabular Impingement? A Prospective Cohort Analysis

2018 ◽  
Vol 46 (13) ◽  
pp. 3111-3118 ◽  
Author(s):  
Sergio E. Flores ◽  
Joseph R. Sheridan ◽  
Kristina R. Borak ◽  
Alan L. Zhang
Keyword(s):  
Patient Outcomes ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Short Form ◽  
Cohort Analysis ◽  
Case Series ◽  
Harris Hip Score ◽  
Physical Component Score ◽  
Level Of Evidence ◽  
Patient Reported

Background: Hip arthroscopy for femoroacetabular impingement (FAI) has been shown to improve patient outcomes, especially for returning to sport. Although previous studies often evaluated outcomes 2 years after hip arthroscopy, there has been no analysis of the progression of patient improvement over time or with respect to achieving the minimal clinically important difference (MCID). Hypothesis/Purpose: The purpose was to prospectively evaluate changes in patient-reported outcome (PRO) scores during the first 2 years after hip arthroscopy for FAI and to analyze when the MCID is achieved. It was hypothesized that clinically significant changes will be reached by 1 year after surgery. Study Design: Case series; Level of evidence, 4. Methods: Patients undergoing hip arthroscopy for FAI were prospectively enrolled, and they completed the 12-Item Short Form Health survey (SF-12), modified Harris Hip Score, and Hip disability and Osteoarthritis Outcome Score (HOOS) at preoperative baseline and 3 months, 6 months, 1 year, and 2 years after surgery. Mean scores and the percentage of patients reaching the MCID at each time point were analyzed via analysis of variance and Cochrane-Armitage trend tests. Results: A total of 129 hips from 122 patients were evaluated, revealing significant improvements after hip arthroscopy for FAI (PRO scores increased 19 to 45 points) with 95.8%, 93.6%, and 84.8% of patients achieving the MCID for HOOS-Sports, HOOS–Quality of Life (QoL), and HOOS-Pain, respectively, at 2-year follow-up. Analysis of PRO change showed that for all scores, the greatest improvement occurred from presurgery to postoperative 3 months, with lesser improvements at subsequent 6-month, 1-year, and 2-year time points ( P < .001). The SF-12 physical component score, HOOS-Sports, and HOOS-QoL continued to show statistically significant improvements through 2 years, while other scores plateaued after 3 months. The percentage of patients achieving the MCID for HOOS-Sports, HOOS-QoL, and HOOS-Pain continued to increase over 2 years, but the percentage achieving the MCID did not increase after 3 months for all other scores. Conclusion: Hip arthroscopy for FAI yields significant improvements in patient outcomes within 2 years of surgery. The majority of improvement occurs within 3 months after surgery, but certain outcomes, such as returning to sport, QoL, and pain, can continue to improve through 2 years.

Defining the Clinically Meaningful Outcomes for Arthroscopic Treatment of Femoroacetabular Impingement Syndrome at Minimum 5-Year Follow-up

2020 ◽  
Vol 48 (4) ◽  
pp. 901-907 ◽  
Author(s):  
Benedict U. Nwachukwu ◽  
Edward C. Beck ◽  
Kyle N. Kunze ◽  
Jorge Chahla ◽  
Jonathan Rasio ◽  
...  
Keyword(s):  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Case Series ◽  
Impingement Syndrome ◽  
Arthroscopic Treatment ◽  
Harris Hip Score ◽  
Outcome Score ◽  
Femoroacetabular Impingement Syndrome ◽  
Patient Reported

Background: Minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) have gained prominence as important variables in the orthopaedic outcomes literature. In hip preservation surgery, much attention has been given to defining early clinically meaningful outcome; however, it is unknown what represents meaningful patient-reported outcome improvement in the medium to long term. Purpose: (1) To define MCID, PASS, and SCB at a minimum 5 years after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) and (2) to evaluate the time-dependent nature of MCID, PASS, and SCB. Study Design: Case series; Level of evidence, 4. Methods: Patients undergoing primary hip arthroscopy for FAIS between January 2012 and March 2014 were included. Clinical and demographic data were collected in an institutional hip preservation registry. MCID, PASS, and SCB were calculated for each outcome score including the Hip Outcome Score–Activities of Daily Living subscale (HOS-ADL), Hip Outcome Score–Sport-Specific subscale (HOS-SS), modified Harris Hip Score (mHHS), and International Hip Outcome Tool (iHOT-12) at 1, 2, and 5 years. MCID was calculated by use of a distribution-based method, whereas PASS and SCB were calculated by use of an anchor method. Results: The study included 283 patients with a mean ± SD age of 34.2 ± 11.9 years. The mean changes in 1-year, 2-year, and 5-year scores, respectively, required to achieve MCID were as follows: HOS-ADL (8.8, 9.7, 10.2); HOS-SS (13.9, 14.3, 15.2); mHHS (6.9, 9.2, 11.4); and iHOT-12 (15.1, 13.9, 15.1). The threshold scores for achieving PASS were as follows: HOS-ADL (89.7, 88.2, 99.2); HOS-SS (72.2, 76.4, 80.9); mHHS (84.8, 83.3, 83.6); and iHOT-12 (69.1, 72.2, 74.3). Last, the threshold scores for achieving SCB scores were as follows: HOS-ADL (89.7, 91.9, 94.6); HOS-SS (78.1, 77.9, 85.8); mHHS (86.9, 85.8, 94.4); and iHOT-12 (72.6, 76.8, 87.5). More patients achieved MCID, SCB, and PASS at 2-year compared with 1-year follow-up; however, by 5 years, fewer patients had achieved clinically meaningful outcome (minimum 1-, 2-, and 5-year follow-up, respectively: MCID, 82.6%, 87.3%, 79.3%; PASS, 67.6%, 74.9%, 67.5%; SCB, 62.3%, 67.2%, 56.6%). Conclusion: The greatest proportion of patients achieved MCID, PASS, and SCB at 2-year follow-up after arthroscopic treatment of FAIS compared with 1- and 5-year time points. Improvements were maintained out to 5-year follow-up, although the proportion of patients achieving clinical significance was slightly decreased.

Bilateral Hip Arthroscopy in High-Level Athletes: Results of a Shorter Interval Between Staged Bilateral Hip Arthroscopies

2020 ◽  
Vol 48 (3) ◽  
pp. 654-660 ◽  
Author(s):  
Jeffrey D. Hassebrock ◽  
Anikar Chhabra ◽  
Justin L. Makovicka ◽  
Kostas J. Economopoulos
Keyword(s):  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Patient Reported Outcomes ◽  
Harris Hip Score ◽  
Return To Sports ◽  
Index Procedure ◽  
Outcome Score ◽  
Significant Difference ◽  
Patient Reported ◽  
High Level

Background: Hip arthroscopy is a safe and effective mechanism for treating femoroacetabular impingement symptoms in high level athletes. Bilateral symptoms occur in a subset of this population. Purpose: To discuss outcomes of bilateral hip arthroscopy in high-level athletes and compare a standard staged timeline for bilateral hip arthroscopic surgery versus an accelerated timeline. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review of all staged bilateral hip arthroscopies was performed on high-level athletes over a 3-year period. Patients were categorized into cohorts based upon when the second procedure was performed (4-6 weeks after the index procedure or >6 weeks after the index procedure). Exclusion criteria included any prior hip surgery, advanced arthritis, previous pelvic or femoral fracture, or inflammatory arthropathy. Demographics, radiographic measurements, operative reports of procedures performed, and patient-reported outcomes (Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sport Specific Subscale, modified Harris Hip Score, return to sports, return to same level of play) were compared between groups at 6-month, 1-year, and 2-year intervals, with the Student t test used for continuous data and a chi-square test used for categorical data. Results: 50 patients were identified: 22 in the accelerated surgery (AS) group and 28 in the standard surgery (SS) group. Age and number of collegiate participants were greater in the AS group, whereas the number of high school participants and the time away from sports were higher in the SS group. Preoperative alpha angles were significantly larger among the AS group, but no differences were found in postoperative alpha angles, center edge angles, or Tönnis grades. No significant difference was seen in patient-reported outcomes between the 2 groups at 6-month, 1-year, and 2-year follow-up. Conclusion: Bilateral hip arthroscopy performed 4 to 6 weeks apart is a safe and effective treatment option for athletes with bilateral femoroacetabular impingement and labral tears; the procedures entail a high rate of return to sports, return to the same level of sports, and decreased time lost from sports. This information could be useful for an athlete deciding on whether to proceed with bilateral hip arthroscopy and deciding on the timing for the procedures.

Age and Outcomes in Hip Arthroscopy for Femoroacetabular Impingement: A Comparison Across 3 Age Groups

2020 ◽  
Vol 49 (1) ◽  
pp. 82-89 ◽  
Author(s):  
Lawrence J. Lin ◽  
Berkcan Akpinar ◽  
David A. Bloom ◽  
Thomas Youm
Keyword(s):  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Older Patients ◽  
Age Groups ◽  
Harris Hip Score ◽  
Failure Rates ◽  
Clinical Failure ◽  
Middle Aged ◽  
Significant Difference ◽  
Patient Reported

Background: Limited evidence exists concerning the effect of age on hip arthroscopy outcomes for femoroacetabular impingement (FAI). Purpose/Hypothesis: The purpose was to investigate patient-reported outcomes (PROs) and clinical failure rates across various age groups in patients undergoing hip arthroscopy for FAI. We hypothesized that older patients would experience lower improvements in PROs and higher clinical failure rates. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 109 of 130 eligible consecutive patients underwent hip arthroscopy for FAI with a minimum 5-year follow-up. Patients were stratified into 3 groups for comparison (ages 15-34, 35-50, and 51-75 years). Clinical survival rates to revision surgery or total hip arthroplasty (THA) were determined by Kaplan-Meier analysis, and PROs were assessed using analysis of variance. Regression analysis was used to determine factors associated with clinical failure and ΔPROs from baseline to 5 years. Results: The 5-year survival-to-revision rate was 71% (survival time, 69.2 months; 95% CI, 62.8 to 75.5 months). A significant difference in survival to THA was found between groups ( P = .030). Being in the older group versus the young and middle-aged groups predicted increased risk of THA conversion (hazard ratio, 5.7; 95% CI, 1.1 to 28.6; P = .035). Overall modified Harris Hip Score (mHHS) and Nonarthritic Hip Score (NAHS) improved from baseline to 5 years (mHHS, P < .001; NAHS, P < .001). Body mass index (mHHS: beta, −1.2; 95% CI, −2.2 to −0.3; P = .013; NAHS: beta, −1.6; 95% CI, −2.6 to −0.5; P = .005) and baseline PROs (mHHS: beta, −0.8; 95% CI, −1.1 to −0.4; P < .001; NAHS: beta, −0.7; 95% CI, −1.1 to −0.4; P < .001) were predictive of 5-year ΔPROs. A decrease was seen in minimal clinically important difference rates in middle-aged ( P = .011) and old ( P = .030) groups from 6-month to 5-year outcomes. Conclusion: Although hip arthroscopy for FAI yielded improvements in PROs regardless of age, middle-aged and older patients experienced greater declines in clinical outcomes over time than younger patients. Older patients remain good candidates for arthroscopy despite a greater risk for conversion to THA.

Rate of Return to Sport and Functional Outcomes After Bilateral Hip Arthroscopy in High-Level Athletes

2019 ◽  
Vol 47 (14) ◽  
pp. 3444-3454 ◽  
Author(s):  
Philip J. Rosinsky ◽  
Cynthia Kyin ◽  
Ajay C. Lall ◽  
Jacob Shapira ◽  
David R. Maldonado ◽  
...  
Keyword(s):  
Hip Arthroscopy ◽  
Case Series ◽  
Return To Sport ◽  
Harris Hip Score ◽  
Complication Rates ◽  
Level Of Evidence ◽  
Entire Cohort ◽  
Patient Reported ◽  
Competitive Athletes

Background: Bilateral hip symptoms are common in athletes, and athletes may require treatment with bilateral hip arthroscopy. Return-to-sport (RTS) rates in competitive athletes after unilateral procedures have been reported at 74% to 93%; however, RTS rates after bilateral hip arthroscopy are still unknown. Purpose/Hypothesis: The purpose was to determine rate of RTS in competitive athletes undergoing bilateral hip arthroscopy and report minimum 1-year patient-reported outcomes (PROs) for this cohort. We hypothesized that after bilateral hip arthroscopy, the RTS rate would be similar to the square of the probability of returning after unilateral hip arthroscopy. Study Design: Case series; Level of evidence, 4. Methods: Data were prospectively collected on patients undergoing hip arthroscopy at our institution from November 2011 to July 2018. Patients were included if they underwent bilateral hip arthroscopy and were a high school, collegiate, or professional athlete before their first surgery. A patient’s RTS was defined as return to competitive participation in one’s sport at a level the same as or higher than the preoperative level. Additionally, minimum 1-year PROs, including modified Harris Hip Score (mHHS), nonarthritic hip score, and Hip Outcome Score–Sports Specific Subscale (HOS-SSS), as well as complication rates and future surgery were compared for all patients. Rates of reaching the minimal clinically importance difference (MCID) and patient acceptable symptomatic state (PASS) for the mHHS (8 and 74, respectively) and HOS-SSS (6 and 75, respectively) were also recorded. Results: A total of 87 patients met inclusion criteria, for which follow-up was available for 82 (94.3%). At latest follow-up, 100% of professional athletes had returned to their sport, while 53.7% of the entire cohort returned to their sport, with 75.8% of male patients returning versus 38.8% of female patients ( P < .001). Of patients returning, 56% did so at the same ability or higher. The most common reason for not returning was graduation or lifestyle change (47.4%). Patients returning to sport had significantly higher PROs at latest follow-up relative to those who did not return, including mHHS (93.7 vs 87.5), nonarthritic hip score (94.4 vs 88.2), and HOS-SSS (90.9 vs 78.2) ( P < .05). Rates of achieving the PASS and MCID for the mHHS were not significantly different. However, for the HOS-SSS, patients who returned had significantly higher rates of achieving the MCID and PASS thresholds. Conclusion: The rate of RTS among competitive athletes after bilateral hip arthroscopy was similar to the square of published RTS rates after unilateral hip arthroscopy. Both those who returned to play and those who did not showed significant improvement in PROs after surgery. However, those who returned to sports achieved significantly higher scores in all outcome measures. Additionally, patients returning to sports showed a significantly higher rate of attaining the MCID and PASS scores for the HOS-SSS.

Midterm Outcomes and Return to Sports Among Athletes Undergoing Hip Arthroscopy

2018 ◽  
Vol 46 (7) ◽  
pp. 1661-1667 ◽  
Author(s):  
Itay Perets ◽  
Matthew J. Craig ◽  
Brian H. Mu ◽  
David R. Maldonado ◽  
Jody M. Litrenta ◽  
...  
Keyword(s):  
High School ◽  
Hip Arthroscopy ◽  
Case Series ◽  
Return To Sport ◽  
Sports Participation ◽  
Harris Hip Score ◽  
Short Version ◽  
Return To Sports ◽  
Patient Reported

Background: Hip arthroscopy is an established surgical treatment for pathologic hip conditions in athletes. There is a paucity in the literature regarding outcomes and return to sport for athletes in the midterm. Purpose: To report minimum 5-year outcomes, return to sport, and level of sport among athletic patients who underwent hip arthroscopy. In addition, we compared 2- and 5-year outcomes to evaluate whether there is a deterioration in functional status. Study Design: Case series; Level of evidence, 4. Methods: Data were prospectively collected on all patients who underwent hip arthroscopy between February 2009 and November 2011 at 1 institution. Athletes at the high school, collegiate, or professional level who underwent hip arthroscopy and had preoperative patient-reported outcome (PRO) scores were considered for inclusion. Exclusion criteria were preoperative Tönnis grade >1 or prior ipsilateral hip conditions or surgery. Data on sports participation, competition level, and ability were collected. At a minimum of 5 years postoperatively, PROs, visual analog scale (VAS), iHOT-12 (short version of International Hip Outcome Tool), satisfaction, and postoperative complication data were collected. Results: Seventy-seven hips met all criteria, among which 66 (85.7%) had a minimum 5-year follow-up and were included. There were 37 high school, 20 collegiate, and 9 professional athletes. Mean ± SD improvements at a minimum of 5 years were as follows: modified Harris Hip Score, 66.8 ± 16.3 to 87.0 ± 14.8 ( P < .001); nonarthritic hip score, 66.2 ± 19.9 to 87.2 ± 15.2 ( P < .001); Hip Outcome Score–Sports Specific Subscale, 47.0 ± 22.4 to 79.1 ± 23.0 ( P < .001); and VAS, 5.4 ± 2.5 to 1.8 ± 2.1 ( P < .001). At latest follow-up, mean iHOT-12 was 78.8 ± 22.7, and satisfaction was 8.2. A total of 50 athletes (53 hips, 80.3%) reported that they returned to sports; 71.2% reported “same” or “higher” sport ability as compared with a year before surgery. Postoperative complications included 3 cases (4.5%) of numbness and 1 case (1.5%) of pulmonary embolism. Ten hips (15.2%) required secondary arthroscopies, and no hips were converted to total hip arthroplasty. There were no significant differences between 2- and 5-year PROs, VAS, or satisfaction. Conclusion: Midterm results of hip arthroscopy in athletes are shown to be safe and favorable. Most athletes return to sports and continue to play after 5 years with the same or higher ability.

scholarly journals Influence of Femoral Version on the Outcomes of Hip Arthroscopic Surgery for Femoroacetabular Impingement or Labral Tears: A Systematic Review and Meta-analysis

2021 ◽  
Vol 9 (6) ◽  
pp. 232596712110091
Author(s):  
Chenghui Wang ◽  
Yaying Sun ◽  
Zheci Ding ◽  
Jinrong Lin ◽  
Zhiwen Luo ◽  
...  
Keyword(s):  
Systematic Review ◽  
Patient Satisfaction ◽  
Femoroacetabular Impingement ◽  
Arthroscopic Surgery ◽  
Harris Hip Score ◽  
Cochrane Library ◽  
Femoral Version ◽  
Labral Tears ◽  
Significant Difference ◽  
Secondary Outcomes

Background: It remains controversial whether abnormal femoral version (FV) affects the outcomes of hip arthroscopic surgery for femoroacetabular impingement (FAI) or labral tears. Purpose: To review the outcomes of hip arthroscopic surgery for FAI or labral tears in patients with normal versus abnormal FV. Study Design: Systematic review; Level of evidence, 4. Methods: Embase, PubMed, and the Cochrane Library were searched in July 2020 for studies reporting the outcomes after primary hip arthroscopic surgery for FAI or labral tears in patients with femoral retroversion (<5°), femoral anteversion (>20°), or normal FV (5°-20°). The primary outcome was the modified Harris Hip Score (mHHS), and secondary outcomes were the visual analog scale (VAS) for pain, Hip Outcome Score–Sport-Specific Subscale (HOS-SSS), Non-Arthritic Hip Score (NAHS), failure rate, and patient satisfaction. The difference in preoperative and postoperative scores (Δ) was also calculated when applicable. Results: Included in this review were 5 studies with 822 patients who underwent hip arthroscopic surgery for FAI or labral tears; there were 166 patients with retroversion, 512 patients with normal version, and 144 patients with anteversion. Patients with retroversion and normal version had similar postoperative mHHS scores (mean difference [MD], 2.42 [95% confidence interval (CI), –3.42 to 8.26]; P = .42) and ΔmHHS scores (MD, –0.70 [96% CI, –8.56 to 7.15]; P = .86). Likewise, the patients with anteversion and normal version had similar postoperative mHHS scores (MD, –3.09 [95% CI, –7.66 to 1.48]; P = .18) and ΔmHHS scores (MD, –1.92 [95% CI, –6.18 to 2.34]; P = .38). Regarding secondary outcomes, patients with retroversion and anteversion had similar ΔNAHS scores, ΔHOS-SSS scores, ΔVAS scores, patient satisfaction, and failure rates to those with normal version, although a significant difference was found between the patients with retroversion and normal version regarding postoperative NAHS scores (MD, 5.96 [95% CI, 1.66-10.26]; P = .007) and postoperative HOS-SSS scores (MD, 7.32 [95% CI, 0.19-14.44]; P = .04). Conclusion: The results of this review indicated that abnormal FV did not significantly influence outcomes after hip arthroscopic surgery for FAI or labral tears.

scholarly journals Villoglandular adenocarcinoma of the uterine cervix: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Anna K. Dietl ◽  
Matthias W. Beckmann ◽  
Konrad Aumann
Keyword(s):  
Systematic Review ◽  
Uterine Cervix ◽  
Case Reports ◽  
Case Series ◽  
Disease Free Survival ◽  
Conservative Group ◽  
Pubmed Database ◽  
Significant Difference ◽  
Stage Ia ◽  
Invasive Management

Abstract Purpose Villoglandular adenocarcinoma (VGA) of the uterine cervix has been classified as a rare subtype of cervical adenocarcinoma with good prognosis. A conservative surgical approach is considered feasible. The main risk factor is the presence of other histologic types of cancer. In this largest systematic review to date, we assess oncological outcomes associated with conservative therapy compared to those associated with invasive management in the treatment of stage Ia and Ib1 VGA. Methods Case series and case reports identified by searching the PubMed database were eligible for inclusion in this review (stage Ia–Ib1). Results A total of 271 patients were included in our literature review. 54 (20%) patients were treated by “conservative management” (conization, simple hysterectomy, and trachelectomy) and 217 (80%) by “invasive management” (radical hysterectomy ± radiation, hysterectomy, and radiation). Recurrences of disease (RODs) were found in the conservative group in two (4%) cases and in the invasive group in nine (4%) cases. There was no significant difference in disease-free survival (DFS) according to conservative or invasive treatment (p = 0.75). The histology of VGA may be complex with underlying usual adenocarcinoma (UAC) combined with VGA. Conclusion The excellent prognosis of pure VGA and the young age of the patients may justify the management of this tumor using a less radical procedure. The histological diagnosis of VGA is a challenge, and pretreatment should not be based solely on a simple punch biopsy but rather a conization with wide tumor-free margins.

scholarly journals The underestimated issue of non-reproducible cardiac troponin I and T results: case series and systematic review of the literature

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Julien Favresse ◽  
Jean-Louis Bayart ◽  
Damien Gruson ◽  
Sergio Bernardini ◽  
Aldo Clerico ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Judgment ◽  
Troponin I ◽  
Troponin T ◽  
Case Reports ◽  
False Negative ◽  
Case Series ◽  
Elevated Alkaline Phosphatase ◽  
Negative Results ◽  
Significant Difference

Abstract Cardiac troponins (cTn) are the preferred biomarkers for the evaluation of myocardial injury and play a key role in the diagnosis of acute myocardial infarction (MI). Pre-analytical or analytical issues and interferences affecting troponin T and I assays are therefore of major concern given the risk of misdiagnosis. False positive troponin results have been related to various interferences including anti-troponin antibodies, heterophilic antibodies, or elevated alkaline phosphatase level. On the other hand, false negative results have been reported in the case of a large biotin intake. These interferences are characterized with erroneous but reproducible troponin results. Of interest, non-reproducible results have also been reported in the literature. In other words, if the sample is reanalyzed a second time, a significant difference in troponin results will be observed. These interferences have been named “fliers” or “outliers”. Compared to the biotin interference that received major attention in the literature, troponin outliers are also able to induce harmful clinical consequences for the patient. Moreover, the prevalence of outliers in recent studies was found to be higher (0.28–0.57%) compared to the biotin interference. The aim of this systematic review is to warn clinicians about these non-reproducible results that may alter their clinical judgment. Four case reports that occurred in the Clinique of Saint-Luc Bouge are presented to attest this point. Moreover, we aimed at identifying the nature of these non-reproducible troponin results, determining their occurrence, and describing the best way for their identification.

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